Duplication Cyst Research Articles

Intestinal duplications: incidentally ileum duplication cyst in young female

Gastrointestinal tract duplication is a rare congenital malformation in young patients and in adults, that occur anywhere from the mouth to the anus and their macroscopic structure may be cystic or tubular.Intestinal duplication does not show specific symptoms, indeed they can present with a variety of symptoms including abdominal distension and pain, sickness, hemorrhage, chronic respiratory disorders, as well as non-painful abdominal mass. Nonetheless, intestinal duplication can remain completely asymptomatic and be diagnosed as an incidental finding. Presentation with acute complications such as intestinal invagination or mechanical occlusion is quite rare.We present a case of asymptomatic ileum duplication cyst in young female who referred to the emergency department for trauma and was screened by eco-Focus Assessment Sonography for Trauma (eco-FAST), followed by MR and CT.The patient underwent ileal resection and prophylactic appendicectomy with ileo-cecal termino-lateral anastomosis. In this case, the intestinal duplication cyst was an asymptomatic incidental finding.

Clinical characteristics and surgical outcome in children with intussusceptions secondary to pathologic lead points: retrospective study in a single institution.

Intussusception secondary to pathologic lead points (PLPs) is a potential surgical emergency and almost all cases need surgery. The aim of this study was to evaluate the clinical manifestations, physical examinations and surgical outcomes of secondary intussusception (SI) caused by PLPs, as well as to improve the diagnosis and treatment of PLPs in children and infants. We retrospectively reviewed the records of 83 children and infants who were diagnosed with intussusception secondary to PLPs in our institution. The ultimate diagnosis was dependent on histopathological findings under a microscope by a pathologist. Patients were divided into a younger group (< 2years old) and the older group (> 2years old) according to age. Patient demographics, clinical manifestations, duration of symptoms, auxiliary examinations, and the presence of pathological lead point were recorded. A total of 83 patients were found with intussusception secondary to PLPs in this study. Patients were aged from 4days to 14 years, with a mean age of 3.8years (median 1.5; range 0-14years). There were 47 cases in the younger group and 36 cases in the older group. The main clinical symptoms were intermittent crying or abdominal pain. PLPs were observed in only ten patients on US (12%). Ten patients underwent enteroscopy examination for further diagnosis, and all the patients had positive findings including seven cases of Peutz-Jeghers syndrome and three cases of benign polyps. Technetium-99m pertechnetate scans were performed in ten patients and five patients had positive results (50%). Based on the surgical findings, complex/compound is the most common type of intussusception, followed by small intestinal and ileo-colic type. The main types of PLPs were Meckel's diverticulum (n = 31), duplication cyst (n = 19) and benign polyps (n = 13). Meckel's diverticulum and intestinal duplication were the most common causes of secondary intussusception among children younger than 2years, accounting for 81% (38/47) of the cases. The most common causes of secondary intussusception in children older than 2years were intestinal polyps, Meckel's diverticulum and Peutz-Jeghers syndrome, accounting for 72% (26/36) of the cases. The presence of a pathological lead point is more likely in older children. The most common types of intussusception secondary to PLPs are complex/compound and small intestinal. Meckel's diverticulum and intestinal duplication were the most common causes of secondary intussusception among younger children and Peutz-Jeghers syndrome and intestinal polyps were commonly seen in older children.

Foregut duplications in the superior mediastinum: beware of a common wall with the tracheo-bronchial tree.

Foregut duplication cysts (FD) with a common muscular wall with the oesophagus are well recognised. Our case series highlights the existence of a common wall between superior mediastinal FD and the tracheo-bronchial tree. Over the last 15 years, we have thoracoscopically resected 41 FD. Five cases were identified to have a common wall with the tracheo-bronchial tree at operation. The clinical history, radiology, findings at operation and pathology were evaluated to highlight learning points. Five superior mediastinal cysts with a common wall were identified, with two antenatally and three postnatally diagnosed. All three postnatal cases and one antenatal case presented with symptoms of respiratory compromise and stridor. Only one neonate was relatively asymptomatic before resection. CT similarities in all cases were: separation of trachea and oesophagus by the cyst, oesophageal deviation to the right or compression and compression of trachea/bronchus. Thoracoscopically, two cysts were resected without injury to the airway, while three had inadvertent tracheo-bronchial injury. Repair of the tracheal injury was possible in one case thoracoscopically, while two cases required conversions, as adequate oxygenation could not be maintained despite on-table endotracheal tube advancement beyond the injury and thoracoscopic manoeuvres. All cases had excellent outcomes at follow-up (median 25months, range 4-39months) with resolution of symptoms and no recurrences. Our report highlights the existence of a common wall between the superior mediastinal FD and the tracheo-bronchial tree. Thoracoscopic resections are feasible including repair of inadvertent airway injury, provided adequate oxygenation can be maintained.

Enteric Duplication Cyst in Infant: Case Report and Literature Review

Enteric Duplication Cyst in Infant: Case Report and Literature Review

Duodenal duplication cysts. A case report of the oldest man in literature

Background: In the cluster of the congenital malformation of gastrointestinal system there is visceral duplication. This is a rare development abnormality that occur mainly in infant and children and is detected for symptoms related to obstruction or to gastrointestinal bleeding. Only 30 % of cases are diagnosed in adult. In Literature, is reported from 1 out of 25,000 to 1 out 100,000 deliveries of duplication of gastrointestinal system, but duodenum duplications are less than 5% of all. Duodenal duplication cysts are usually located in the second or the third part of duodenum, and can communicate with duodenal lumen or be extended into posterior mediastinum, communicate with gall bladder or communicate with the pancreaticobiliary duct.

Adult Gastric Bronchogenic Cyst With Elevated Tumor Marker in Containing Fluid: A Case Report and Literature Review

Introduction: Duplication cysts are rare malformations that exist in the alimentary tract, and the mucosa of gastric bronchogenic cyst lined by pseudostratified columnar ciliated epithelium (PCCE) is even more rare. We reviewed related literatures to depict this unique abnormality. Case presentation: Herein we report an abdominal mass that was found incidentally in a 52-year-old female. The biochemical test of contents revealed a high concentration of tumor markers unusually. A laparoscopic surgery was undertaken to remove the lesion. The cyst was found to originate from the stomach but did not show any anatomic communication with the stomach lumen. Pathologic examination confirmed the mucosa was lined by PCCE. Conclusion: The symptoms and radiologic presentations of GDC are nonspecific. It should be distinguished with other abdominal cystic masses. Surgery is advised in respective of malignancy.

EUS-specific stents: Available designs and probable lacunae.

Interventional EUS has seen exponential growth in its indications and applications in the last decade.[1,2,3] Dedicated endoscopic devices for EUS-guided interventions are still limited. Up until recently, the tools used have been borrowed from other procedures such as ERCP. In interventional EUS, the linear-array echoendoscope allows a needle to be advanced under EUS-guidance from the upper gastrointestinal lumen to the biliary, pancreatic, or another adjacent intestinal lumen. Real-time puncture can be performed and provide the possibility of EUS-guided transluminal drainage (EUS-TLD). Plastic stents and conventional self-expandable metallic stents (SEMSs) were initially used but present several limitations due to their design.[1,4,5] They lack lumen-to-lumen anchorage and present migratory risks in the absence of stricture to hold them in place. Plastic stents are associated with potential pneumoperitoneum and bile peritonitis, whereas fully-covered SEMS (FCSEMS), despite preventing bile leak, will not maintain secure apposition between two nonadherent organs. Furthermore, their length often exceeds the anatomical requirement of a shorter transluminal anastomosis and predisposes them to obstruction as well as difficult positioning. With the rise in new EUS-guided interventional techniques, new tools, in particular, new stent designs have evolved to facilitate the various applications. A few EUS-specific stents have now become available for EUS-TLD.[4,5] We hereby review the stent designs and discuss lacunae to be addressed to improve the efficacy, safety, and ease of procedures.

Thoracoscopically Resected Esophageal Duplication Cyst with High Value of Serum CA19-9 at the First Visit—Report of a Case—

Thoracoscopically Resected Esophageal Duplication Cyst with High Value of Serum CA19-9 at the First Visit—Report of a Case—

Duodenal duplication in an infant

Bilious vomiting is a relevant sign in children that requires immediate evaluation and diagnosis. One of the causes is an obstruction of the intestinal tract due to duplication if located distal to the major duodenal papilla of Vater. Most of the duplications involve the jejunum, stomach, and colon. Duodenal duplications are very rare and can have an endoscopic or surgical treatment after diagnosis. We are reporting here a case of duodenal duplication in a 3-month-old male child who presented to us with bilious vomiting. Most of them are associated with other anomalies. Completely isolated duodenal duplication is very rare. Therefore, we tried to review the topic while presenting this rare case report of isolated duodenal duplication cyst.

Mesenteric Hydatid Cyst

The aim of this article is to make radiologists and clinicians familial with the spectrum of cystic lesions in the abdomen. Mesenteric and omental cystic lesions are uncommon. One should be familiar with them as well as with other conditions that manifest as cysts. Initial step in diagnosing a cystic abdominal mass is to localize the organ of origin. Differential diagnosis includes enteric duplication cyst, enteric cyst, mesothelial cyst, non pancreatic pseudocyst, cystic mesothelioma, cystic teratoma, and urachal cyst. There is significant overlap in imaging features of abdominal cysts, which often require histological correlation to establish a final diagnosis. The main role of imaging is to document the nature of the abdominal mass and its origin.

Adenomyoma causing gastric outlet obstruction

Abstract We report an adenomyoma in a 15-year-old girl with an obstructing pyloric mass. Histologic examination of the resected specimen showed irregular glands and smooth muscle cells consistent with adenomyoma. Our review of the literature showed seven other similar pediatric cases where these hamartomas mimic the presentation of hypertrophic pyloric stenosis as well as duplication cysts radiographically and are difficult to biopsy endoscopically. While rare, gastric adenomyomas are benign but require complete surgical resection for diagnostic clarity and therapeutic resolution of obstruction.

Laparoscopic double cholecystectomy for biliary dyskinesia in a child with duplicated gallbladders

Abstract Gallbladder duplication is an uncommon congenital anomaly with an estimated incidence of 1 in 4000 patients. Here we present a child who underwent a duodenal duplication cyst marsupialization who continued experiencing chronic abdominal pain one year after the initial procedure. She had an incidentally discovered duplicated gallbladder on ultrasound and an ejection fraction of 2% on hepatobiliary iminodiacetic acid (HIDA) scanning. Preoperative magnetic resonance cholangiopancreatography (MRCP) revealed two gallbladders with individual cystic ducts. She underwent an uneventful laparoscopic double cholecystectomy for biliary dyskinesia and subsequently had resolution of her chronic abdominal pain.

Gastric duplication cyst in an adult with autoimmune hemolytic anemia: a case report and review of the\xa0literature

BackgroundGastric duplication cysts are uncommon congenital anomalies found primarily in children and rarely seen in the adult population. Accurate diagnosis of cysts before resection is difficult even using the most advanced imaging techniques.Case presentationIn this report, we describe a 28-year-old Moroccan patient with a history of autoimmune hemolytic anemia who presented with an asymptomatic abdominal cystic mass detected during abdominal computed tomography performed before splenectomy. Magnetic resonance imaging performed for accurate characterization showed a high-signal-intensity cystic mass on T2-weighted images, located between the patient’s stomach and spleen. The patient underwent a complete cyst resection during exploratory laparotomy. The histological examination showed a cyst lined by three different epithelia with bundles of smooth muscle, which suggested a gastric duplication cyst.ConclusionsWe report a case of gastric cyst duplication in an adult with autoimmune hemolytic anemia, and we discuss this rare association, radiological findings, and the unique histological findings of this case.

Congenital Esophageal Duplication Cyst-A Rare Case Report and Review of Literature

Alimentary tract duplication is a relatively rare congenital anomaly. Esophageal duplication cyst is an uncommon developmental anomaly among them. Respiratory symptoms are the most common symptoms in foregut duplication, most case present with respiratory distress which may be present from birth, or symptoms may insidious with cough, wheeze, or recurrent respiratory infection. We present a case of newly born baby with respiratory distress, which on radiological investigation showed left mediastinal mass that was removed by excisional biopsy and final histopathology revealed an esophageal cyst.

Enteric duplication in children.

Enteric duplication is a congenital anomaly with varied clinical presentation that requires surgical resection for definitive treatment. This had been approached with laparotomy for resection, but has changed with minimally invasive technique. The purpose of our study was to determine the demographics, natural history, operative interventions, and outcomes of pediatric enteric duplication cysts in a contemporary cohort. With IRB approval, we performed a retrospective chart review of all patients less than 18years old treated for enteric duplication between January 2006 and August 2016. Demographics, patient presentation, operative technique, intraoperative findings, hospital course, and follow-up were evaluated. Descriptive statistical analysis was performed; all medians were reported with interquartile range (IQR). Thirty-five patients underwent surgery for enteric duplication, with a median age at surgery of 7months (2.5-54). Median weight was 7.2kg (6-20). Most common patient presentations included prenatal diagnosis 37% (n = 13). Thirty-four patients (97%) had their cyst approached via minimally invasive technique (thoracoscopy or laparoscopy) with only three (8%) requiring conversion to an open operation. Median operative time was 85min (54-133) with 27 (77%) patients requiring bowel resection. Median length of bowel resected was 4.5cm (3-7). Most common site of duplication was ileocecal (n = 15, 42%). Postoperative median hospital length of stay was 3days (2-5) and median number of days to regular diet was 3 (1-4). No patients required re-operation during their hospital stay. Median follow-up was 25days (20-38). In our series, most enteric duplication cysts were diagnosed prenatally. These can be managed via minimally invasive technique with minimal short-term complications, even in neonates and infants.

Duplication Cyst with Intestinal Volvulus Causing Intestinal Atresia/Stenosis in Neonates

Duplication cysts of small bowel seldom present in newborns and usually represent the development of complications. In utero complications may lead to mesenteric vascular accidents and thus resulting in intestinal atresias. We report three neonates with duplication cyst of small bowel causing localized intestinal volvulus, leading to small bowel intestinal atresia/stenosis. The neonates underwent excision of the duplication cyst and resection anastomosis of the small bowel. Post-operative recovery was uneventful in all three of them.

An Esophageal Perforation Due to an Infected Duplication Cyst - Avoiding Surgery Is Still Possible!

An Esophageal Perforation Due to an Infected Duplication Cyst - Avoiding Surgery Is Still Possible!

Rare Presentation of Esophageal Duplication Cyst in Adult

Introduction: Esophageal duplication cyst (EDC) is an unusual mediastinal cyst which commonly presents with pulmonary infection, dyspnea or dysphagia due to compression of adjacent structures during childhood. In very few cases, it can remain asymptomatic until adolescence, eventually needing intervention due to symptoms and complications. We present a rare case of EDC in an adult who was admitted with pneumonia. Case Description:A 57 year old woman with no significant past medical history came to the emergency department with productive cough for one week associated with fever of 102°Fahrenheit. On examination, she had crackles in the right lower lobe of the lung. Her labs were only significant for white blood cell count of 12300 cells/uL. Chest X-ray showed right paratracheal mass and right lower lobe infiltrate. Computed tomography (CT) scan of chest revealed right lower lobe opacities and right large fluid-filled paratracheal cyst compressing esophagus and trachea. Barium swallow examination demonstrated leftward deviation of proximal esophagus without any communication with the cyst. Mediastinal mass was further evaluated by endoscopic ultrasound (EUS) which exhibited a 5cm homogeneous anechoic cystic structure contained within the third layer of esophagus with no blood flow, consistent with an EDC [figure 1]. She was started on Ceftriaxone and Azithromycin for management of community acquired pneumonia with improvement in symptoms over the next three days. On stabilization, she underwent video assisted thoracoscopic resection of the cyst and appeared to be doing well on one month follow up. Discussion: EDC is diagnosed in childhood in up to 80% of the cases and less than 7% remain asymptomatic until adolescence. It can cause local compressive symptoms as well as complications like hemorrhage, rupture into pleura and progression to malignancy. Diagnosis is usually made by EUS which can help in the differentiation of solid from cystic lesions. EDC should be promptly treated in symptomatic patients and resection can be performed through open thoracotomy or video-assisted thoracoscopic surgery. Biopsy and aspiration of the asymptomatic cyst is not recommended because of the potential for complications and cyst infection. Physicians should be aware of this rare condition to facilitate early diagnosis and treatment.1733 Figure 1 No Caption available.

MYCOBACTERIUM AVIUM COMPLEX MEDIASTINAL LYMPHADENITIS IN AN IMMUNOCOMPETENT ADOLESCENT WITH EROSION INTO THE AIRWAY

SESSION TITLE: Kid cases SESSION TYPE: Fellow Case Reports PRESENTED ON: 10/07/2018 03:30 PM - 04:30 PM INTRODUCTION: Mycobacterium avium complex (MAC) is associated with bronchiectasis and is seen in children with cervical lymphadenitis. It is rarely described in older immunocompetent children. CASE PRESENTATION: A 15-year-old male presented with 4 days of back pain, cough, fever, and pleuritic chest pain. Patient was febrile, 98% SpO2 on room air, tachycardic, with wheezing and rhonchi. D-dimer was elevated. Chest CT revealed a posterior mediastinal soft tissue mass (6.2 cm in diameter) with intra-lesional air abutting the right bronchus intermedius (Figure 1). MRI did not suggest a neurogenic tumor. Empiric IV antibiotics were initiated to treat a presumably infected bronchogenic duplication cyst. The mass was resected via VATS (Figure 2). Post-operatively, a persistent air leak developed. Due to concern for airway injury or bronchial fistula, flexible bronchoscopy was performed, revealing an atypical orifice along the medial wall of the bronchus intermedius (Figure 3). Interrogation revealed a sac like structure. This was presumed to be an accessory cardiac bronchus, a rare anatomic bronchial variant. This structure was in close proximity to the resected tissue and presumably communicated with the pleural space. Histologic evaluation of the resected soft tissue mass identified lymph nodes with necrotizing granulomas without airway or lung tissue. No pathogens were identified and acid-fast bacilli (AFB) smear was negative. A subsequent sputum specimen smear was AFB positive with positive identification of MAC via nucleic acid hybridization. Sputum culture grew MAC at 19 days. Immunologic and infectious evaluations were unremarkable. A treatment course of azithromycin, rifampin, and ethambutol was initiated. Repeat bronchoscopy with BAL performed 2 months after presentation revealed resolution of previous airway abnormality, with negative AFB smear and culture on BAL fluid. Chest CT obtained 3 months after antibiotic therapy revealed resolution of the posterior mediastinal mass. DISCUSSION: Initial bronchoscopy was suggestive of an underlying airway anomaly (cardiac bronchus) as a possible nidus for MAC infection, and subsequent mediastinal erosion. However, given lack of bronchoscopic and imaging evidence supporting a persistent airway anomaly, this case is most consistent with MAC associated mediastinal lymphadenitis complicated by formation of a bronchial fistula. CONCLUSIONS: This case highlights an unusual presentation of MAC mediastinal lymphadenitis with erosion into the airway in an immunocompetent teenager. Although rare in children, MAC mediastinal lymphadenitis needs to be considered in the differential diagnosis of mediastinal masses, especially in patients with respiratory symptoms. If there is evidence on chest imaging of close communication between a mediastinal mass and the airways, clinicians should have a low threshold to perform bronchoscopy to closely evaluate the airways. Reference #1: Nolt, D., Michaels, M. G., & Wald, E. R. (2003). Intrathoracic disease from nontuberculous mycobacteria in children: two cases and a review of the literature. Pediatrics, 112(5), e434-e434. Reference #2: Freeman, A. F., Olivier, K. N., Rubio, T. T., Bartlett, G., Ochi, J. W., Claypool, R. J., … & Holland, S. M. (2009). Intrathoracic nontuberculous mycobacterial infections in otherwise healthy children. Pediatric pulmonology, 44(11), 1051. Reference #3: Desir, A., & Ghaye, B. (2009). Congenital abnormalities of intrathoracic airways. Radiologic clinics of North America, 47(2), 203-225. DISCLOSURES: No relevant relationships by Jason Caboot, source=Web Response No relevant relationships by Benjamin Garren, source=Web Response

GASTRIC DUPLICATION CYST: A RARE CONGENITAL ANOMALY

Gastrointestinal (GI) duplication is defined as a spherical structure, with a muscular coat lined by a mucous membrane in the alimentary tract is a rare congenital anomaly. In this report, we present a case of a 14-year-old male child with complaints of epigastric pain for 1 month. Computed tomography scan of the abdomen was suggestive of two cystic lesions in the stomach. Exploratory laparotomy was performed with excision of cysts. Histopathology of both cysts was suggestive of gastric duplication cyst.